Varenicline for smoking cessation in people with schizophrenia: a double blind randomized pilot study

Weiner, Elaine; Buchholz, A; Coffay, Agnes; Liu, Fang; McMahon, Robert P.; Boyer, Robert; Kelly, Deanna L.

doi:10.1016/j.schres.2011.02.003

Cited by 61 publications

(62 citation statements)

References 16 publications

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“…a self-reported 0 cigarettes smoked in the preceding 7 days confirmed by expired CO level of less than 10 ppm). One study defined quit as expired CO level less than 10 ppm at each of the last 4 visits [45], and one study didn't specify how they define smoking cessation [42].…”

Section: Discussionmentioning

confidence: 99%

“…Full-text assessments of the remaining 11 potentially relevant articles excluded a further three studies [37][38][39]. A total of eight studies (398 participants) met the selection criteria and were included in the analysis [40][41][42][43][44][45][46][47]. The included studies were published between 2011 and 2014.…”

Section: Included Studiesmentioning

confidence: 99%

“…Four trials, with a total of 240 participants, reported smoking abstinence rates after 12 weeks of treatment with varenicline [40,42,45,46]. The pooled results ( Figure 2) show that participants using varenicline were more than four times more likely to abstain from smoking at the end of the treatment than the placebo groups (RR 4.33, 95% CI 1.96 to 9.56, I² = 0%, p=0.910).…”

Section: Effectiveness Of the Interventionsmentioning

confidence: 99%

“…The weighted mean difference in smoking reduction was 6.39 (95% CI: 2.22-10.56); i.e., smoking was reduced in the varenicline group by 6.39 more cigarettes per day than in the placebo group. But there was substantial heterogeneity among trials (I² = 89.2%, p<0.001), this is largely due to one trial in which smoking reduction was much higher in the varenicline group than the placebo group [45].…”

Section: Effectiveness Of the Interventionsmentioning

confidence: 99%

“…Amongst the studies included in this review, a majority of studies reported no significant difference between varenicline and control groups in terms of neuropsychiatric events in people with SMIs [40][41][42][44][45]47]. Only one study reported a significantly increased risk of suicidal ideation in the varenicline group (one case) compared with the placebo group (no cases) [43].…”

mentioning

confidence: 99%

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Varenicline for smoking cessation and reduction in people with severe mental illnesses: systematic review and meta-analysis

Gilbody

Peckham

et al. 2016

Addiction

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ReuseItems deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. The publisher or other rights holders may allow further reproduction and re-use of the full text version. This is indicated by the licence information on the White Rose Research Online record for the item. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request.This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/add.13415 This article is protected by copyright. All rights reserved. COMPETING INTERESTS None. 2This article is protected by copyright. All rights reserved. ABSTRACT AimsTo determine the effectiveness and safety of varenicline in treating tobacco dependence in patients with severe mental illness.Design A systematic review and meta-analysis of randomised controlled trials that compared varenicline with a placebo or an alternative intervention for smoking cessation or reduction.Setting Both in-patient and out-patient settings in any country.Participants Adult patients aged 18 and over with any type of severe mental illness. The systematic review included eight studies comprising 398 participants.Measures Primary outcome measures were (1) smoking cessation (2) smoking reduction measured by changes in the number of cigarettes smoked per day and (3) number of psychiatric adverse events, which were collected at the end of treatment. FindingsThe random-effect pooled estimates from the five studies that reported smoking related outcomes found that varenicline is statistically superior to placebo in smoking cessation (risk ratios 4.33; 95% CI: 1.96-9.56), and smoking reduction was higher in varenicline groups (mean reduced daily cigarettes was 6.39; 95% CI: 2.22-10.56). There is no significant difference regarding neuropsychiatric and other adverse events.Conclusions Varenicline appears to be significantly more effective than placebo in assisting with smoking cessation and reduction in people with severe mental illness. There appears to be no clear evidence that varenicline was associated with an increased risk of neuropsychiatric or other adverse events compared with placebo. 3This article is

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Section: Discussionmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Effectiveness Of the Interventionsmentioning

confidence: 99%

Section: Effectiveness Of the Interventionsmentioning

confidence: 99%

mentioning

confidence: 99%

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Varenicline for smoking cessation and reduction in people with severe mental illnesses: systematic review and meta-analysis

Gilbody

Peckham

et al. 2016

Addiction

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Maintenance Treatment With Varenicline for Smoking Cessation in Patients With Schizophrenia and Bipolar Disorder

Evins

Cather

Pratt

et al. 2014

JAMA

197

193

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IMPORTANCE It is estimated that more than half of those with serious mental illness smoke tobacco regularly. Standard courses of pharmacotherapeutic cessation aids improve short-term abstinence, but most who attain abstinence relapse rapidly after discontinuation of pharmacotherapy.OBJECTIVE To determine whether smokers diagnosed with schizophrenia and bipolar disease have higher rates of prolonged tobacco abstinence with maintenance pharmacotherapy than with standard treatment. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, placebo-controlled, parallel-group, relapse-prevention clinical trial conducted in 10 community mental-health centers. Of 247 smokers with schizophrenia or bipolar disease recruited from March 2008-April 2012, 203 received 12-weeks' open-label varenicline and cognitive behavioral therapy and 87 met abstinence criteria to enter the relapse prevention intervention.INTERVENTIONS Participants who had 2 weeks or more of continuous abstinence at week 12 of open treatment were randomly assigned to receive cognitive behavioral therapy and double-blind varenicline (1 mg, 2 per day) or placebo from weeks 12 to 52. Participants then discontinued study treatment and were followed up to week 76. MAIN OUTCOMES AND MEASURESSeven-day rate of continuous abstinence at study week 52, the end of the relapse-prevention phase, confirmed by exhaled carbon monoxide. Secondary outcomes were continuous abstinence rates for weeks 12 through 64 based on biochemically verified abstinence and weeks 12 through 76, based on self-reported smoking behavior.RESULTS Sixty-one participants completed the relapse-prevention phase; 26 discontinued participation (7 varenicline, 19 placebo) and were considered to have relapsed for the analyses; 18 of these had relapsed prior to dropout. At week 52, point-prevalence abstinence rates were 60% in the varenicline group (24 of 40) vs 19% (9 of 47) in the placebo group (odds ratio [OR], 6.2; 95% CI, 2.2-19.2; P < .001). From weeks 12 through 64, 45% (18 of 40) among those in the varenicline group vs 15% (7 of 47) in the placebo group were continuously abstinent (OR, 4.6; 95% CI, 1.5-15.7; P = .004), and from weeks 12 through 76, 30% (12 of 40) in the varenicline group vs 11% (5 of 47) in the placebo group were continuously abstinent (OR, 3.4; 95% CI, 1.02-13.6; P = .03). There were no significant treatment effects on psychiatric symptom ratings or psychiatric adverse events.CONCLUSIONS AND RELEVANCE Among smokers with serious mental illness who attained initial abstinence with standard treatment, maintenance pharmacotherapy with varenicline and cognitive behavioral therapy improved prolonged tobacco abstinence rates compared with cognitive behavioral therapy alone after 1 year of treatment and at 6 months after treatment discontinuation.

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Nicotine receptor partial agonists for smoking cessation

Stead

Lancaster

2012

Cochrane Database of Systematic Reviews

225

143

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BACKGROUND: Nicotine receptor partial agonists may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). OBJECTIVES: The primary objective of this review is to assess the efficacy and tolerability of nicotine receptor partial agonists, including cytisine, dianicline and varenicline for smoking cessation. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group's specialised register for trials, using the terms ('cytisine' or 'Tabex' or 'dianicline' or 'varenicline' or 'nicotine receptor partial agonist') in the title or abstract, or as keywords. The register is compiled from searches of MEDLINE, EMBASE, PsycINFO and Web of Science using MeSH terms and free text to identify controlled trials of interventions for smoking cessation and prevention. We contacted authors of trial reports for additional information where necessary. The latest update of the specialized register was in December 2011. We also searched online clinical trials registers. SELECTION CRITERIA: We included randomized controlled trials which compared the treatment drug with placebo. We also included comparisons with bupropion and nicotine patches where available. We excluded trials which did not report a minimum follow-up period of six months from start of treatment. DATA COLLECTION AND ANALYSIS: We extracted data on the type of participants, the dose and duration of treatment, the outcome measures, the randomization procedure, concealment of allocation, and completeness of follow-up. The main outcome measured was abstinence from smoking at longest follow-up. We used the most rigorous definition of abstinence, and preferred biochemically validated rates where they were reported. Where appropriate we pooled risk ratios (RRs), using the Mantel-Haenszel fixed-effect model. MAIN RESULTS: Two recent cytisine trials (937 people) found that more participants taking cytisine stopped smoking compared with placebo at longest follow-up, with a pooled RR of 3.98 (95% confidence interval (CI) 2.01 to 7.87). One trial of dianicline (602 people) failed to find evidence that it was effective (RR 1.20, 95% CI 0.82 to 1.75). Fifteen trials compared varenicline with placebo for smoking cessation; three of these also included a bupropion treatment arm. We also found one open-label trial comparing varenicline plus counselling with counselling alone. We found one relapse prevention trial, comparing varenicline with placebo, and two open-label trials comparing varenicline with nicotine replacement therapy (NRT). We also included one trial in which all the participants were given varenicline, but received behavioural support either online or by phone calls, or by both methods. This trial is not included in the analyses, but contributes to the data on safety and tolerability. The included studies covered 12,223 participants, 8100 of whom used varenicline. The pooled RR for continuous or sustained abstinence at six ...

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Varenicline for smoking cessation in people with schizophrenia: a double blind randomized pilot study

Cited by 61 publications

References 16 publications

Varenicline for smoking cessation and reduction in people with severe mental illnesses: systematic review and meta-analysis

Varenicline for smoking cessation and reduction in people with severe mental illnesses: systematic review and meta-analysis

Maintenance Treatment With Varenicline for Smoking Cessation in Patients With Schizophrenia and Bipolar Disorder

Nicotine receptor partial agonists for smoking cessation

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